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[en] The coronavirus 2019 (COVID-19) outbreak poses a serious public health risk. To date, the disease has affected almost all countries in the world. The enormous scale of the outbreak and the relative lack of knowledge and information regarding a new virus, as well as the unpredictability of events, make it challenging for leadership teams to respond. This paper shares how we have reconfigured our radiology leadership team into a smaller disease outbreak task force (DOTF) to respond and coordinate all related efforts during this ongoing COVID-19 pandemic. The DOTF format is modelled after the military with domain groups looking at manpower, intelligence, operations, and logistics matters on a daily basis so that timely decisions can be made and action plans executed promptly. In managing the DOTF, discipline, flexibility, and teamwork are key principles, and these are built upon a strong foundation of focus on infection prevention and control, and patient and staff safety as well as staff well-being. The DOTF has positioned us well to confront the many challenges to date. We believe it will also help us navigate the complex issues that will arise with future surges in cases and in formulating strategies to manage exit from the present and future lockdowns.
[en] The CNSC (Canadian Nuclear Safety Commission) evaluates the safety performance of nuclear power plant (NPP) licensees and prepares an annual report on their safety performance referred to as the Regulatory Oversight Report, which is presented to the Commission and is subsequently published on the CNSC web page. Prior to 2017, the report was referred to as the Regulatory Oversight Report for Canadian NPPs. However, in 2017, the report was expanded to include the safety performance evaluation of waste management facilities located at NPP sites. The report has been renamed as the Regulatory Oversight Report for Canadian Nuclear Power Generating Sites. The CNSC evaluates how well licensees meet regulatory requirements and CNSC expectations for the performance of programmes in 14 safety and control areas (SCAs) that are grouped in accordance with their functional areas of management, facility and equipment, or core control processes. These SCAs are further divided into 71 specific areas that define the key components of the SCA. The functional areas, SCAs and the specific areas that are used in CNSC’s safety performance evaluation are presented. An example of safety performance ratings for Canadian NPPs is given. An example of a conclusion of a CNSC Regulatory Oversight Report for Canadian Nuclear Power Generating Sites is as follows: The evaluations of all findings for the SCAs show that, overall, NPP licensees made adequate provisions for the protection of health, safety and security of Canadians and the environment from the use of nuclear energy, and took the necessary measures to implement Canada’s international obligations.
[en] CT-guided percutaneous needle biopsy of the spine is a well-described technique for determining the nature of indeterminate vertebral lesions or establishing a diagnosis of spinal infection, the high diagnostic accuracy and the safety of the procedure having been extensively documented. The purpose of the current article is to review the literature to date on CT-guided spinal biopsy. Specifically, indications for spinal biopsy, techniques for optimising yield, detail of the approaches for various spinal levels which is dependent upon both the region within the spinal column and lesion location within the vertebra (body vs. neural arch), determinants of biopsy outcome and complications are covered. It is hoped that the review will be of particular benefit to junior radiologists who are required to perform this procedure.
[en] In 2018, EDF operated a standardized fleet in France: 58 pressurized water reactors from one vendor and one licence through the 900 MW series (34 reactors); the 1300 MW series (20 reactors); and the 1450 MW series (4 reactors). In total, 75% of the fleet was built between 1979 and 1990, the oldest reactor is 40 years old and the average age of the fleet is 30 years. Thus, LTO programmes and plant life management have been key issues for years.The principles of asset management as mentioned in ISO55000:20141 are implemented in EDF processes, from strategic levels to working levels. If the main goals are shared inside the company, the nuclear operating branch is organized following several programmes (e.g.ageing management, obsolescence, maintenance and optimization, refurbishment for major components) and projects (e.g. periodic safety reviews, post Fukushima improvements) that are quite autonomous to contribute in maintaining or improving the value of the assets.
[en] To identify and prioritize technical procedures for simulation-based training that should be part of the education of residents in radiology. This European-wide needs assessment study used a modified Delphi technique to gather consensus from different key education stakeholders in the field. The first round was a brainstorming phase to identify all procedures that a newly specialized radiologist should potentially be able to do. In the second round, each procedure was explored for the need for simulation training; the participants determined frequency, number of radiologists performing the procedure, impact on patient comfort and safety, and feasibility of simulation. The result of this round was sent back to the participants for final evaluation and prioritization. Seventy-one key education stakeholders from 27 European countries agreed to participate and were actively involved in the Delphi process: response rates were 72% and 82% in the second and third round, respectively. From 831 suggested procedures in the first round, these were grouped and categorized into 34 procedures that were pre-prioritized in the second round according to the need for simulation-based training. In the third round, 8 procedures were eliminated resulting in final inclusion of 26 procedures. Ultrasound procedures were highly ranked including basic skills such as probe handling; abdominal ultrasound; and ultrasound of kidneys, retroperitoneum, intestines, and scrotum. The prioritized list of procedures represents a consensus document decided upon by educational stakeholders in radiology across Europe. These procedures are suitable for simulation and should be an integral part of the education of radiologists.
[en] In Indian Pressurised Heavy Water Reactors (IPHWRs) calandria tubes are rolled with end shield tube sheet at either ends with the help of a sandwich type joints. These calandria tubes are generally kept unchanged during en-masse replacement of pressure tubes and end-fittings; probably due to unavailability of technology for replacement of calandria tube. But in recent past, one irradiated calandria tube has been replaced successfully from one of the 220 MWe IPHWRs, with a new one, with the help of Calandria Tube Rolled Joint Detachment (CTRJD) system, developed by Reactor Engineering Division of Bhabha Atomic Research Centre (BARC). This paper gives brief description of CTRJD system, methodology of calandria tube rolled joint detachment, shop floor trials of the technique for optimisation of operating parameters, qualification trials at full length mock up facility and deployment at reactor site. (author)
[en] An effective regulatory framework is essential to the success of a national nuclear power programme. The IAEA has developed the Milestones approach to help Member States embarking on nuclear power to understand and develop the necessary infrastructure requirements in a phased way. The regulatory framework is one of the 19 infrastructure issues that are described in the Milestones approach. The primary objective of this publication is to present the experiences of selected Member States that are in the process of building or expanding their regulatory framework for a nuclear power programme, including the challenges they faced. The publication also provides insights on IAEA safety requirements and guidance on establishing an effective regulatory framework with reference to the IAEA Safety Standards Series, the IAEA Nuclear Security Series, and IAEA Safeguards guidance publications. In addition, it demonstrates how these requirements fit into the overall development of a nuclear power programme through the IAEA Milestones approach.
[en] To evaluate the safety and effectiveness of tibiopedal and distal femoral access for retrograde crossing of chronic total occlusion (CTO) in Rutherford stage III to VI peripheral arterial occlusive disease, and to determine factors that correlate with technical success. One hundred seventy-one consecutive patients were included in this retrospective study. Rutherford stages were III, IV, and V/VI in 24%, 8%, and 67% of patients. Inclusion criteria were CTO at the superficial femoral (SFA), popliteal (PA), and/or below-the-knee (BTK) level, and a failed antegrade treatment followed by a distal retrograde approach. The numbers of occluded vascular levels (OVL), lesion length, degree of calcification, technical success rate, complications, and clinical outcome were noted. OVL were 1 in 72%, 2 in 20%, and 3 in 8% of patients. CTOs were longer than 20 cm in 45.6% of cases and showed severe calcifications in 50.3%. Target vessels for distal access were the distal SFA/PA in 17% and BTK in 83%. The overall technical success rate was 82%. Severe calcification decreased technical success (p = 0.01) despite lesion length and Rutherford stage. Clinical outcome improved in 123/152 patients with a significant increase of the median ABI (N = 158) from 0.53 (interquartile range 0.39 to 0.61) to 0.85 (0.59 to 1.03; p < 0.001). Complications were reported in 7.6% cases with 2.3% related to the distal vascular access. The tibiopedal and distal femoral retrograde access presents a safe and effective treatment option of CTOs at the thigh and/or BTK after a failed antegrade attempt improving clinical outcome. Technical success decreased with lesion’s degree of calcification.
[en] Regulatory Infrastructure Development - IAEA Assistance: Facilitating implementation of legal instruments; Develop internationally recognized safety standards - Safety fundaments, requirements and guides, - Guidance on establishing safety infrastructure; Provide services for implementation of safety standards - Peer reviews services; Provide quality support and assistance to Member States developing safety infrastructure - Capacity building (training courses, workshops, fellowships and scientific visits); Facilitating exchange of regulatory and operating experience; Coordinate and collaborate effectively with other organizations; Facilitating stakeholders engagement, communication and public understanding
[en] Endovascular treatment (EVT) has been widely used for treating acute ischemic stroke (AIS). However, the safety and efficacy of treating AIS with tirofiban combined with EVT remain controversial. Therefore, we conducted a meta-analysis to evaluate this treatment. Randomized controlled trials and cohort studies that compared treatment with tirofiban combined with EVT and EVT alone were included in our meta-analysis. Those published from inception to March 31, 2020, were searched using the PubMed, Web of Science, Embase, and Cochrane Library databases. Safety was assessed based on symptomatic intracranial hemorrhage (sICH) incidence and 3-month mortality. Efficacy was assessed based on modified Rankin Scale (mRS) scores at 3 months post-EVT and recanalization rates. Data were analyzed using either the random-effects or fixed-effects model based on the heterogeneity of studies. In total, one RCT, six prospective studies, and four retrospective studies (2387 AIS cases) were assessed. Our meta-analysis showed that tirofiban combined with EVT did not increase sICH risk (RR, 1.06; 95%CI, 0.79 to 1.42; P = 0.72) and 3-month mortality (RR, 0.87; 95%CI, 0.74 to 1.04; P = 0.12). Recanalization rates were not significantly different between patients treated with tirofiban combined with EVT and those treated with EVT alone (RR, 1.04; 95%CI, 1.00 to 1.08; P = 0.07), but tirofiban combined with EVT was significantly associated with favorable functional outcomes (mRS score, 0–2) in AIS patients (RR, 1.13; 95%CI, 1.02 to 1.25; P = 0.02). Tirofiban combined with EVT appears to be safe and potentially effective in treating AIS.